This might surprise some. With abortion insurance and Medicaid coverage and state-level protections to keep abortion legal if Roe v. Wade is overruled, Washington bucks national trends toward anti-abortion legislation. But even here, 59% of counties, where 10% of Washington’s women live, don’t have an abortion clinic, according to data from the Guttmacher Institute, a reproductive health policy organization.
Medical abortion by mail is a new way for people living in these underserved areas to access care. Washington patients can now seek care at digital clinics such as Hi Jane or virtual consultations with established local physical clinics like Cedar River, which has offices in Seattle, Tacoma and Renton. Since medical abortions typically end pregnancy using mifepristone and a second drug, misoprostol, making the pills available by mail means patients can safely abort at home without visiting a clinic. The non-surgical option, which is effective in terminating pregnancies up to 10 weeks gestation, is becoming increasingly common, accounting for 39% of all abortions in the United States in 2017, according to Guttmacher. During the COVID-19 pandemic, medical abortion had the added benefit of not requiring in-office surgery – and the risks of exposure that came with it.
Ying Zhang, a Seattle-based family physician, said that during the pandemic, many family planning providers across the country had “put protocols in place to provide no-contact medical abortion where patients could seek care without having to to get there”. “
This would not have been possible before the overthrow of the Biden administration. The Food and Drug Administration previously subjected mifepristone to what is called a risk assessment and mitigation strategy. or REMS, a restriction limiting distribution to specific providers in hospitals, doctors’ offices and clinics. This means the drug was not available in pharmacies, despite objections from the American College of Obstetricians and Gynecologists that “there is no safety reason for the restrictions”.
But in April, when the FDA temporarily lifted REMS on mifepristone under the Biden administration, Acting FDA Commissioner Janet Woodcock confirmed in a letter to the group of obstetricians and gynecologists that the existing data “did not appear to show an increase in serious safety issues. …occurring with medical abortion following the change in in-person delivery requirement during the COVID-19 pandemic.
With REMS no longer a factor, providing medical abortion via telehealth has been made much easier for some patients and providers. “Without the [REMS] injunction, people still should have gone there to get the medicine,” Zhang said. Now they don’t have to.
But the change has not fully taken effect everywhere. “Several providers have begun providing medical abortion care via telehealth, but unfortunately there remain financial and logistical barriers to expanding this care here and across the country,” said Lisa Humes-Schulz, vice president. -President of Policy and Regulatory Affairs at Planned Parenthood Alliance Advocates, which promotes reproductive health care in Washington, Alaska and Idaho.
These logistical challenges include restrictions in 34 states banning medical abortion altogether, requiring abortive medications to be taken in the physical presence of a physician (despite the medication’s safety record and low complication rate), or requiring medications are dispensed by a physician (despite data from health care organizations suggesting that providers like physician assistants can also provide safe care). Idaho is one of the states that requires a doctor to dispense mifepristone and misoprostol.
Full implementation of medical abortion by mail has been particularly complicated in Idaho, said Dusty Ginner, board member of the Northwest Abortion Access Fund, which helps people pay for abortion care in Washington, Oregon, Idaho and Alaska. Ginner said the fund worked with two Idaho providers on implementation. But “we’re still working to figure out how to get Idaho on the list,” she said.
Although the expansion has improved access to abortion in some rural communities governed by left-leaning state legislatures, she said, it hasn’t had the same effect in states where the Access to abortion was already under siege from the start. “I would say that even people in rural Washington and Oregon generally have more access to abortion than people in the more populated area of Idaho or even Alaska,” Ginner said. .
Logistics are further complicated by a shortage of providers willing to facilitate abortion care. “Even though we technically have telehealth access to medical abortion here, there are so few local providers who are willing to engage,” Ginner said.
It’s also unclear how long the FDA will grant a grace period to the risk assessment and mitigation strategy on mifepristone. Humes-Schulz of Planned Parenthood said she hopes the Trump administration’s “medically unnecessary in-person requirements for medical abortion are permanently eliminated,” and that Medicaid patients in particular will have access to the medical abortion by mail.
But if medical abortion by mail is scaled back again, it could drive patients to the only other source currently available for mail-order abortion drugs: self-managed abortion.
While this may raise the specter of unsafe pre-Roe abortions, mainstream health care organizations are increasingly recognizing self-managed medical abortion as a safe and effective way to access abortion care, as long as it uses the same medications, dosage and timing of pregnancy. used in a medical setting, with access to medical care if patients want or need it.
According to a report by the World Health Organization on self-managed abortion published in June: “Evidence has demonstrated that during the first trimester, individuals can safely and effectively manage their own medical abortions using mifepristone and misoprostol in combination. This strategy can offer crucial support in providing access to safe abortion care.
Guttmacher describes the ideal model of self-managed abortion as one in which patients can easily and safely obtain misoprostol and mifepristone, and seek medical assistance if desired.
Organizations such as Aid Access and Plan C already provide information on where patients can buy abortion drugs online, as well as information on how the drugs work. They also give very detailed advice to patients in states where mailing abortion medication is difficult; these include creative workarounds, like mail forwarding.
The FDA’s decision to allow medical abortion by mail explicitly states that it is intended to last only for the duration of the pandemic. If the rule reverts to Trump-era restrictions, self-managed abortion may be the only way for some patients to receive a medical abortion by mail.
As Zhang said, “All these politicians who are restricting and banning abortion — that’s not going to stop abortion in our country. People will find ways to take care of themselves.